PMID- 17932588
OWN - NLM
STAT- MEDLINE
DCOM- 20090709
LR  - 20211020
IS  - 0828-282X (Print)
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 23 Suppl B
IP  - Suppl B
DP  - 2007 Oct
TI  - Treatment delays in patients undergoing primary percutaneous coronary 
      intervention for ST elevation myocardial infarction at the Quebec Heart and Lung 
      Institute.
PG  - 53B-57B
AB  - BACKGROUND: Current guidelines for ST elevation myocardial infarction (STEMI) 
      recommend performing primary percutaneous coronary intervention (PCI) within 90 
      min of hospital arrival. However, recent data suggest that in a real-world 
      setting, median door-to-balloon (DTB) time is closer to 180 min for transfer 
      patients, with less than 5% of patients being treated within 90 min. A 
      retrospective observational study was conducted to assess time to treatment in 
      patients undergoing primary PCI at the Quebec Heart and Lung Institute (QHLI). 
      METHODS: Consecutive lytic-eligible patients undergoing primary PCI at the QHLI 
      for STEMI between April 2004 and March 2005 were included in the present 
      analysis. The primary evaluation was DTB time measured from arrival at the first 
      hospital to first balloon inflation. Clinical outcomes were in-hospital death, 
      reinfarction and bleeding. DTB times and hospital outcomes of patients 
      transferred from referring hospitals were compared with those of patients 
      presenting directly to the QHLI. RESULTS: During the study period, 203 
      lytic-eligible patients were treated with primary PCI. Sixty-nine patients 
      presented directly to the QHLI and 134 were transferred from other hospitals. Six 
      transfer patients were excluded because of missing time variables. The median DTB 
      time was 114 min in transfer patients, compared with 87 min in patients 
      presenting directly to the QHLI (P<0.001). DTB time was less than 90 min in 24% 
      of the transfer population compared with 55% of patients presenting directly to 
      the QHLI (P<0.001). In patients referred from hospitals within a radius of 30 km 
      from the QHLI (n=100), median DTB time was 106 min with 30% receiving PCI within 
      90 min. In these patients, estimated PCI-related delay was 74 min. For patients 
      presenting to hospitals beyond 30 km (n=28), median DTB time was 142 min with 4% 
      receiving reperfusion within 90 min. In these patients, estimated PCI-related 
      delay was 110 min. Median DTB time for patients presenting during off hours at 
      the QHLI was 92 min compared with 79 min for patients presenting during regular 
      business hours (P=0.02). In patients transferred from other hospitals, median DTB 
      time was 118 min during off hours and 108 min during normal business hours 
      (P=0.07). CONCLUSIONS: A DTB time of less than 90 min can be achieved in the 
      majority of patients presenting directly to a primary PCI centre. However, for 
      patients presenting to community hospitals, transfer for primary PCI is often 
      associated with delayed revascularization. The present study highlights the need 
      for careful patient selection when deciding between on-site thrombolytic therapy 
      and transfer for primary PCI for STEMI patients presenting to hospitals without 
      PCI facilities.
FAU - Garceau, Patrick
AU  - Garceau P
AD  - Quebec Heart and Lung Institute, Laval Hospital, Sainte Foy, Quebec City, Quebec.
FAU - Dery, Jean-Pierre
AU  - Dery JP
FAU - Lachance, Philippe
AU  - Lachance P
FAU - Grenier, Stefanie
AU  - Grenier S
FAU - Rodes-Cabau, Josep
AU  - Rodes-Cabau J
FAU - Barbeau, Gerald
AU  - Barbeau G
FAU - Bertrand, Olivier F
AU  - Bertrand OF
FAU - Gleeton, Onil
AU  - Gleeton O
FAU - Larose, Eric
AU  - Larose E
FAU - Nguyen, Can Man
AU  - Nguyen CM
FAU - Noel, Bernard
AU  - Noel B
FAU - Proulx, Guy
AU  - Proulx G
FAU - Roy, Louis
AU  - Roy L
FAU - de Larochelliere, Robert
AU  - de Larochelliere R
LA  - eng
PT  - Journal Article
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
EIN - Can J Cardiol. 2009 Mar;25(3):140
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Cardiology/trends
MH  - Female
MH  - *Health Services Accessibility
MH  - *Health Services Needs and Demand
MH  - Hospitals, Community
MH  - Humans
MH  - Male
MH  - Medicine
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - Patient Transfer
MH  - Quebec
MH  - Retrospective Studies
MH  - Specialization
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC2794463
EDAT- 2007/12/06 09:00
MHDA- 2009/07/10 09:00
PMCR- 2008/10/01
CRDT- 2007/12/06 09:00
PHST- 2007/12/06 09:00 [pubmed]
PHST- 2009/07/10 09:00 [medline]
PHST- 2007/12/06 09:00 [entrez]
PHST- 2008/10/01 00:00 [pmc-release]
AID - S0828-282X(07)71011-5 [pii]
AID - cjc23053b [pii]
AID - 10.1016/s0828-282x(07)71011-5 [doi]
PST - ppublish
SO  - Can J Cardiol. 2007 Oct;23 Suppl B(Suppl B):53B-57B. doi: 
      10.1016/s0828-282x(07)71011-5.